Beruflich Dokumente
Kultur Dokumente
CONTRIBUTIONS TO PSYCHOANALYTIC
PSYCHOTHERAPY
In this article, I discuss the impact of race and ethnicity on the psychotherapeu-
tic process of three patients in psychoanalytic psychotherapy with an African
American therapist. The influence of race on the treatment process has been
explored infrequently in psychoanalytic writing, despite consensus that it is
conceptually and clinically relevant. This outcome stems from the complex web
of attitudes attending talk about race in this country. Race and ethnicity remain
topics that engender anxiety in social and clinical discourse. I selectively and
critically review the psychoanalytic literature on race, which has been ham-
pered by incomplete conceptualizations and overgeneralizations that often limit
its clinical utility. I then explore, through clinical examples, the way in which
attention directed at racial issues provided a framework for the treatment
alliance and illuminated key transferences and resistances for these patients.
Discussion of racial issues is most fruitful when racial themes are situated in
bodily and social contexts and when the meaning that race has within the
therapy dyad is negotiated by patient and therapist, apart from idealized or
socially correct conceptualizations from outside of the treatment situation.
In this article, I discuss the impact of race and ethnicity on the psychothera-
peutic process and the development of meanings associated with race for
Requests for reprints should be sent to Kimberlyn Leary, PhD, University of Michigan, 527
East Liberty Street, Suite 209D, Ann Arbor, MI 48104.
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analytic clinician can focus on the amalgams of fantasy and reality to which
talk about race is heir and discover the idiosyncratic purposes to which it has
been put.
The following clinical material illustrates some of the difficulties inherent
in this kind of work as well as the potential benefits. The clinical approach
presented here extends the work of Holmes (1992) in discussing how race
may function as a vehicle through which core developmental issues, key
transferences, and related countertransferences may be transported to the
clinical situation. How that vehicle may be driven or be halted in its tracks
is the topic that will be considered next.
CASE ILLUSTRATION 1:
LEARNING FROM ERRORS
slaves when his dad was a boy. I agreed there were slaves but not when lis
dad was a boy. Michael insisted otherwise saying, "There are slaves eve y-
where." This time I assented and invited him to say more, but he said no
more about Blacks or slaves during the remainder of the session.
At the next appointment, Michael began by reciting the colors of he
American flag, chanting "red, white and blue" over and over again. I sai i 1
thought Michael was reminding us of the important talk we'd had abi ut
people's colors. Michael then proposed that we play a game he cal 3d
"slave." I immediately noted to myself that I felt some uneasiness with t lis
game, but I consented. I was instructed that I was the slave and Michael, i :ie
boss. My discomfort increased as the patient, enacting the part of a ruthli ss
master, demanded a series of increasingly impossible tasks. Michael as i le
master pretended to beat me with an imaginary whip. The young patie it,
standing over me, was breathless after his exertions. I learned from him tl at
slaves had to go to sleep early, attend school, and were compelled to co n-
plete "stupid" chores. In short, in Michael's world, slaves were equivalent to
children. I could then communicate how scared, little, and humiliated
"slaves" could feel and how much they would rather be like power ul
"master" parents so as not to feel so small and ashamed and to exact th •ir
revenge.
In discussion of these hours with my senior colleague, I commented >n
my discomfort with my patient's slave game, especially the relish with whi ;h
he seemed to enjoy being my master. Before supervision, I felt vagut ly
troubled about how all this would appear to an onlooker. My colleag le
echoed my anxiety. Concern was expressed about the consequences of 1 t-
ting Michael continue in this vein. Both my supervisor and I were quick to
note how stimulated Michael appeared at the end of the session, discuss :d
how burdensome feeling that powerful had been to him, and were worri :d
about the impact of his treating me in a degrading and demeaning mann :r.
The supervisor suggested, and I agreed, that as the treatment rules includ :d
the provision that no one got hurt, and because in the slave game the sla 'e
got "hurt," that this game would come to an end. It was agreed that I wot Id
tell Michael that even though the game would stop, he and I could still U Ik
about slave and master feelings.
When I suggested this to Michael, he nodded gravely. And though he la' ;r
listened thoughtfully to me talk about master and slave feelings, never age in
did he speak of slaves directly, even though these themes permeated \ is
material through other venues.
In this series of interactions, I believe that an error occurred: Talk a id
actions connected with the topic of race were met with an overemphasis in
reality. I responded to the patient's announcement that I was tan with a
reality: Though tan, I was "Black." Although accurate, this young patien 's
reluctance to conclude that 1 was Eilack went unaddressed, even thou ;h
Michael himself had raised the question of whether I was Black or White. A
similar misstep was narrowly averted when I attempted again to correel a
RACE AND ETHNICITY 1 35
In the following vignette, my race was dealt with differently. The patient and
I were able to use my race as a stepping stone to important transferences and
to build useful understandings. Mr. A., a 25-year-old gay White man, pre-
sented for treatment with concerns about his inability to make long-term
commitments to romantic partners or to enjoy comfortable friendships with
either men or women. In most encounters, he flaunted his considerable
intellectual talents and was caustic and cutting. Following such self-dis-
plays, Mr. A. suffered enormous anxiety. Now desperately contrite, he
awaited castigation. Over time, we came to understand that his driven need
to force himself on others and the punishment he expected in return were
connected to important early experiences with his mother. The ritual of
exposing himself to an expected retaliatory attack reflected, in part, Mr. A.'s
rather profound anxieties about his maleness, which he dealt with coun-
terphobically. While growing up, he had felt painfully excluded by his
mother, the provocative autocratic authority of the family home who favored
his younger sisters. Mr. A.'s posturing with friends and colleagues showed
his efforts to affirm his worth as a male but also brought with them the fear
that such exposure would result in damage and humiliating loss.
Mr. A. made a number of references to race and ethnic background during
the early months of his therapy. During one session, he expressed near
outrage when a college acquaintance invited him to attend a synagogue
service where she was to be the cantor. As we explored this, it became clear
136 LEARY
that Mr, A. was nearly beside himself with envy and rage because his fri ;nd
had so easily assumed that he would want to watch her perform. Mr. A. ra led
against this woman's supposed view of herself as special and unique, wl ich
he came to link—tentatively at first-—with her being a Jew, one of the
"chosen people." In the same session, he lacerated Black students at a 1( cal
college whom he believed had been offered admission because of affirma ive
action. I was able to speak to how outraged Mr. A. felt that Jews and Bte :ks
could so easily allow themselves to be "chosen" and "affirmed" when for his
part, Mr. A. felt so unclaimed, so ill-considered, and so uncomfort; ble
because of the danger he associated with standing out himself.
With some hesitation, Mr. A. began to refer more specifically to my r; ce.
At the time, he viewed me as a wild and provocative woman, similar to his
mother. For example, when I shifted my leg, Mr. A. wondered if it migh be
a seductive invitation. When I moved my hand, Mr. A. reported his expe> ta-
tion that I planned to scratch my crotch in his presence. My race becarr s a
mechanism for greater elaboration of these ideas when Mr. A. found him: elf
alternately fascinated and repelled by my hair. When I responded with :he
request that he tell what he saw and imagined, he initially limited himsel to
a reality, saying "You have a lot of hair." Emboldened by this, he went 01 to
say that my hair was not only big, but untamed, wild, and bushy. Further, he
thought I wore it with abandon. Additional associations included his vi ;w
that my hair was like a lion's mane and compared my hair to that of
Medusa—full of snakes. He also thought with some amusement that my w ild
hair reminded him of his mother's pantyhose drawer, entangled and o\ sr
flowing. When I noted that it is the male lion who has a mane, we be ter
understood his experience of my hair: For Mr. A., my hair was experiem eel
as a provocative appropriation of what belonged to men, and to himself in
particular. This reflected his view that his mother's power in his family \ as
acquired by dint of disarming men of what was rightfully theirs.
During another session, Mr. A. mentioned, with a great deal of embarra ;s-
ment, that he had experienced a "racist" thought: As children, he and lis,
sisters had mimicked Black English to tease and amuse one another. I as! eri
him to tell me about it. Instead of describing his memory, to our mut lal
surprise, Mr. A. began to speak in a high strung approximation of Bh ck
English in a southern dialect. Mr. A. immediately felt ashamed and out ol
control. He had the sudden wish that I would respond in kind and speak in
Black English with him. When I again invited him to say more, he s. id
perhaps I had spoken this way before I went to college and graduate scho )1,
when I was a girl at home. I asked him about Black girls who spoke with h m
like this. He told me that he had known few Black people closely, but so ne
Black kids had been bussed to his school. He remembered that a loud gro jp
of Black girls had "adopted" him in junior high. He thinks they were troub e-
makers, but they called him "sweetheart" and playfully teased him about'. is
"skinny White-boy ass." Mr. A. had felt secretly flattered by their attentic ns
and covertly enjoyed being singled out. Reflecting on this memory, I si g-
RACE AND ETHNICITY 137
gested to Mr. A. that his use of Black English and desire for me to respond
in kind reflected a wish that we could be Black girls together. I suggested
that he felt that if we could both be Black girls together, then we could also
be provocative and not worry about getting into trouble. I also said that I
thought he felt that if we were both Black girls together, we could appreciate
the attributes that White boys had and what they could offer, in a way he felt
his mother had not been able to do for him. With this, we were able to
explore in sharper relief his long, frustrated wish to be admired and cher-
ished for his differences, including his maleness.
With this patient, race and ethnic background provided a fertile soil in
which important transferences could germinate. This was so, I believe, to the
extent that patient and therapist could negotiate what meaning race was to
have within the dyad. Negotiations of this sort are by no means limited to
talk about race and ethnicity but define the framework of all dynamic
understanding (cf. Goldberg, 1987). In these interactions, for example, atten-
tion to the range of meanings the patient attached to Blackness (e.g., the
freedom to be affirmed and provocative and to comfortably draw attention to
one's self) as well as establishing the bodily context of race and ethnicity
(i.e., my hair and the Black girls' playful comments about his "White-boy
ass") contributed to understanding the patient's unique concerns and idio-
syncratic psychology. Again, such negotiations stand in counterdistinction to
the social realities of race to which patient, therapist, or both may be bound
outside of the consulting room.
issues about which she felt she had no one with whom she could openly talk.
Over time, Ms. B. and I were able to piece together some understanding of
her reactions toward the unilateral decision to assign her to a Black therapist,
though this remained an issue about which the patient could not speak openly
and which I believe resulted in a genuine therapeutic process remaining just
out of reach.
CONCLUSIONS
ACKNOWLEDGMENT
Earlier versions of this article were presented at the Duke University Psy-
chology Colloquium in February 1993 and as part of the Race and Ethnicity
in Psychoanalytic Psychotherapy panel at the April 1992 meeting of the
American Psychological Association, Division 39, in Philadelphia.
REFERENCES
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Calnek, M. (1970). Racial factors in the counter-transference. American Journal of Psychiatry,
135, 1084-1096.
Curry, A. (1964). Myth, transference and the black psycho-therapist. Psychoanalytic Review, 51,
7-14.
Fischer, N. (1971). An interracial analysis: Transference and counter-transference. Journal of
the American Psychoanalytic Association, 19, 736-745.
Gardner, L. (1971). Therapeutic relationships under varying conditions of race. Psychotherapy,
18, 78-87.
Goldberg, A. (1987). Psychoanalysis and negotiation. Psychoanalytic Quarterly, 56, 109-129.
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